INFLUENCE OF MIXED VENOUS PO-2 AND INSPIRED O-2 FRACTION ON INTRAPULMONARY SHUNT IN PATIENTS WITH SEVERE ARDS
INFLUENCE OF MIXED VENOUS PO-2 AND INSPIRED O-2 FRACTION ON INTRAPULMONARY SHUNT IN PATIENTS WITH SEVERE ARDS
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DOI：
10.1152/jappl.1995.78.4.1531
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发表时间：
1995-04-01
影响因子：
3.3
通讯作者：
RADERMACHER, P
中科院分区：
文献类型：
--
作者：
ROSSAINT, R;HAHN, SM;RADERMACHER, P
在12例接受体外膜肺氧合治疗严重急性呼吸窘迫综合征（ARDS）的患者中，我们通过多种惰性气体消除技术评估了混合静脉氧分压（P（$）over bar v（o2））和吸入氧分数（FIo 2）的独立变化对通气和灌注分布的影响。降低通过膜肺的恒定气流的氧浓度使我们能够将P（$）相对于bar v（o2）降低约20 Torr，而与心输出量和FIo 2的变化无关，以及增加FIo 2而不影响P（$）相对于bar v（o2）。这些干预措施未引起心率或全身或肺血流动力学的任何变化。一般来说，在重度ARDS患者中，无论是在FIo 2为0.6的机械通气期间，还是在FIo 2为1.0的机械通气期间，P（$）相对于bar v（o2）的降低都不会引起肺血流分布的变化。然而，在个别患者中，P（$）下降超过bar v（o2）或在FIo 2为1.0时通气量与肺内分流的变化相关。因此，我们的结论是，这是不可能预测的影响，这种干预措施在肺气体交换的个别患者患有急性呼吸窘迫综合征。由疾病本身引起的局部血流分布调节的差异可能解释了这种现象。
In 12 patients undergoing extracorporeal membrane oxygenation for treatment of severe acute respiratory distress syndrome (ARDS), we examined the effects of independent variations in mixed venous oxygen tension (P ($) over bar v(o2)) and inspired oxygen fraction (FIo2) on the distribution of ventilation and perfusion as assessed by the multiple inert gas elimination technique. Reducing the oxygen concentration of the constant gas stream through the membrane lungs allowed us to decrease the P ($) over bar v(o2) by similar to 20 Torr independently of variations in cardiac output and FIo2 as well as to augment FIo2 without influencing P ($) over bar v(o2). The interventions did not induce any change in heart rate or systemic or pulmonary hemodynamics. In general, neither during mechanical ventilation at FIo2 of 0.6 nor during mechanical ventilation at FIo2 of 1.0 did the reduced P ($) over bar v(o2) cause variations in the distribution of pulmonary blood flow in our patients with severe ARDS. Nevertheless, in individual patients, decreasing P ($) over bar v(o2) or ventilation at FIo2 of 1.0 was associated with changes in intrapulmonary shunt. Therefore, we conclude that it is not possible to predict the influence of such interventions in pulmonary gas exchange in the individual patient suffering from ARDS. Differences in the regulation of the local distribution of blood flow caused by the disease itself might explain this phenomenon.